Why it's done

Combination birth control pills are a reliable form of contraception that's easily reversed. Fertility can return to normal almost immediately after stopping the pills. Other, noncontraceptive benefits of these pills include:

  • Decreased risk of ovarian and endometrial cancers, ectopic pregnancy, ovarian cysts, benign breast disease
  • Improvement in acne
  • Less-severe menstrual cramps (dysmenorrhea)
  • Reduction in androgen production caused by polycystic ovary syndrome
  • Reduction in heavy menstrual bleeding due to uterine fibroids and other causes, as well as a reduction in related iron iron-deficiency anemia
  • Relief from premenstrual syndrome (PMS)
  • Shorter, lighter and more-predictable periods or, for some types of combination pills, fewer periods yearly
  • Better control of monthly cycle and a reduction in hot flashes for women nearing menopause (perimenopause)

Combination birth control pills come in different mixtures of active and inactive pills, including:

  • Conventional pack. The most common type contains 21 active pills and seven inactive pills. Formulations containing 24 active pills and four inactive pills, known as a shortened pill-free interval, also are available.

    You take a pill every day and start a new pack when you finish the old one (every 28 days). Bleeding occurs every month during the week when you take the last four to seven inactive pills.

  • Continuous dosing or extended cycle. These typically contain 84 active pills and seven inactive pills. Bleeding generally occurs only four times a year during the seven days you take the inactive pills.

    A 365-day pill also is available. You take this pill every day at the same time. For some women, periods stop altogether. For others, periods become significantly lighter.

Continuous-dosing and extended-cycle pills might provide additional benefits of suppressing menstruation, such as:

  • Prevention and treatment of excessive bleeding related to uterine fibroids
  • Prevention of menstrual migraines
  • Reduction in menstruation-associated worsening of certain conditions, including seizures
  • Relief from pain related to endometriosis

Combination birth control pills aren't appropriate for everyone, however. Your health care provider might suggest you take another form of birth control if you:

  • Are in the first month of breast-feeding
  • Are older than 35 and smoke
  • Have poorly controlled high blood pressure
  • Have a history of or current deep vein thrombosis or pulmonary embolism
  • Have a history of stroke or heart disease
  • Have a history of breast cancer
  • Have migraines with aura
  • Have diabetes-related complications, such as nephropathy, retinopathy or neuropathy
  • Have liver disease
  • Have unexplained uterine bleeding
  • Will be immobilized for a prolonged period due to major surgery
Nov. 15, 2017
  1. Hatcher RA, et al. Combined (estrogen & progestin) contraceptives. In: Managing Contraception 2017-2018. 14th ed. Tiger, Ga.: Bridging the Gap Foundation; 2017.
  2. Frequently asked questions. Contraception FAQ185. Combined hormonal birth control: Pill, patch and ring. American College of Obstetricians and Gynecologists. http://www.acog.org/Patients/FAQs/Combined-Hormonal-Birth-Control-Pill-Patch-and-Ring. Accessed Sept. 29, 2017.
  3. Martin KA. Overview of the use of estrogen-progestin contraceptives. https://www.uptodate.com/contents/search. Accessed Sept. 29, 2017.
  4. Stewart M, et al. Choosing a combined oral contraceptive pill. Australian Prescriber. 2015;38:6.
  5. Martin KA. Risks and side effects associated with estrogen-progestin contraceptives. https://www.uptodate.com/contents/search. Accessed Sept. 29, 2017.
  6. Hatcher RA, et al. Combined oral contraceptives (COCs). In: Contraceptive Technology. 20th edition. New York, N.Y.: Ardent Media Ltd.; 2011.

Combination birth control pills